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Digital technologies provide a convenient and scalable approach to dietary assessment and personalised feedback, facilitating behaviour change. This is essential for reducing the prevalence of non-communicable diseases at a population level. However, the evaluation of the acceptability and feasibility of dietary feedback delivered via online platforms has not been thoroughly investigated. By utilising the term ‘system architecture’ to describe the essential components of the digital approach to capturing dietary feedback, this systematic review outlines the platform, dietary assessment methodology, reference values for assessing dietary intake, and elements of personalised dietary feedback. When reported, the acceptability and feasibility of personalised feedback were captured. OVID Medline, OVID Embase, Scopus via Elsevier, and Cinahl Plus via EBSCO identified 5,839 studies. Search terms included dietary assessment, feedback, and digital technologies. In total, 28 studies involving 301,271 participants were included. Food frequency questionnaires were the most commonly used dietary assessment method, accessed via web-based platforms. Dietary intake was commonly assessed using a diet quality index, and feedback was provided on food groups, often combined with a diet quality score or macronutrient analysis. While participant acceptance of personalised dietary feedback was generally high, the overall completion rates for acceptability questionnaires were low, and feasibility was seldom reported. Methods used to measure acceptability and feasibility varied, preventing comparisons across studies. Study quality was high; however, future research would benefit from the involvement of stakeholders and end-users in designing feedback messages.
Understanding service users’ knowledge of and attitudes towards the rapidly progressing field of mental health technology (MHT) is an important endeavour in clinical psychiatry.
Methods:
To evaluate the current use of and attitudes towards MHT (mobile apps, online therapy and counselling, telehealth, web-based programmes, chatbots, social media), a 5-point Likert-scale survey was designed based on previous studies and distributed to attendees of an adult community mental health service in Ireland. Chi-square tests were used and corrected for multiple comparisons.
Results:
107 mental health service users completed the survey (58% female, aged 18–80). 86% of respondents owned a smartphone. 27.1% reported using a mental health application, while 33.6% expressed interest in using one in the future. 61.7% reported they had not used and were not interested in using AI for their mental health, and 51.4% indicated they would not feel comfortable using it. 46.8% were not comfortable with psychiatrists utilising AI in their care. The majority (86.9%) preferred face-to-face appointments, while 52.6% would consider using MHT while on a waiting list. Younger participants reported significantly greater comfort using mental health apps and higher self-rated knowledge of AI.
Conclusion:
There were low levels of knowledge about and comfort using MHT, accompanied by concerns about confidentiality and privacy. Younger service users tended to be more comfortable with and knowledgeable about MHT. Despite the growing interest in digital approaches, there remains a clear preference for face-to-face appointments, underscoring the importance of addressing privacy and safety concerns, together with training and education.
Mobile health (mHealth) interventions offer promising ways to enhance access and continuity of mental health services in low-resource settings. However, little is known about the perspective of end users in routine primary care in Nigeria regarding the role of mHealth in mental health care. This qualitative study explored the perspectives of patients, caregivers and healthcare providers on the use of mHealth tools to support access to and continuity of mental health care in Nigeria. Seventeen participants, including persons with lived experience of depression (n=7), caregivers (n=3), and primary healthcare workers (n=7), were purposively recruited from nine primary health clinics in Ibadan. Interviews were conducted in Yoruba, transcribed, translated into English, and analysed inductively using NVivo 15. Participants identified phone calls, Short Message Service (SMS) reminders, and audiovisual content as key facilitators of engagement, self-care and adherence. Caregivers valued direct communication with providers, while healthcare workers used mobile tools for reminders, follow-up and patient education. Flexible use of next-of-kin contacts helped overcome digital barriers. The findings demonstrate that user-friendly mHealth tools are feasible for supporting mental health care in Nigeria, but their success depends on coupling technology with human-centred communication to ensure equitable and continuous care.
Critical illness survivorship necessitates comprehensive care delivery paradigms across the continuum of care. In recent years, ICU follow-up clinics have emerged to meet the dynamic needs of ICU survivors and their care partners. The advent of novel technologies including teleconferencing, wearables, and sensors, has facilitated the development of telemedicine-based ICU follow-up clinics, leveraging objective asynchronous assessments, physiological data monitoring, and virtual care to make follow-up care more broadly accessible. Further, telemedicine-based ICU follow-up clinics may allow for more personalized care, allowing providers to provide timely, data driven care regardless of physical location. With regulatory body support of telemedicine and virtual care, telemedicine-based ICU follow up clinics may stand to improve patient outcomes and reduce fragmentation of care using digital health solutions.
Digital health services in Kenya comprise mobile health applications (mHealth apps), electronic health records, telehealth and telemedicine, which form part of an expanding digital health assemblage. These are shaped by transnational development agendas and donor-driven public health interventions. This paper discusses the for-profit turn in the digitalisation of health care – what I term the ‘appisation’ of health – as a site of intensified commodification where users are reconfigured as digitised health consumers. While other scholars have argued that digitalisation functions as extractive in deepening market penetration into spheres of life we rely on, I extend these arguments by claiming that, far from enhancing access, these technologies exploit vulnerabilities through opaque governance mechanisms and algorithmic decision-making, while transferring responsibility for health from the state to the individual, thus creating new dependencies on market-mediated platforms. Using discursive interface analysis of two health apps in Kenya, I examine how consumer health apps embed vulnerabilities while consumer law remains structurally limited in confronting the collective harms they generate.
The question of how digital health is regulated has become increasingly important within debates on technology, inequality and global health. While digital health is frequently celebrated for its capacity to expand access, build resilient systems and advance equity, scholars have raised critical concerns about its role in reproducing asymmetries of power. The potential for reproducing rather than curbing inequality is particularly relevant for the Global South. This Special Issue of the International Journal of Law in Context interrogates the ways in which digital health infrastructures, regulatory frameworks and transnational data flows are constitutive of coloniality and neoliberal capitalism. Bringing together socio-legal, feminist and decolonial perspectives, the contributions examine regulation as a terrain in which vulnerabilities, exclusions and structural inequalities are reinforced. Against the celebratory rhetoric of innovation, this collection situates regulation as a key site for understanding the entanglement of digital health with broader histories of coloniality and capitalism.
The promise of digitalisation in achieving Universal Health Coverage in postcolonial contexts is undermined by the realities of insufficiently resourced public healthcare systems. In response, private health insurance is often seen as essential to healthcare delivery. The provision of this private health insurance is increasingly mediated through digital infrastructures, with providers leaning into the promise of data-driven behavioural economics to provide better and more efficient services. While an increasing number of studies focus on digital health, in this paper, we particularly focus on the less-explored question of how datafication – under the veil of shared value, and enabled by forms of legal access – reproduces inequalities. Using the case study of Discovery, a financial services company in South Africa providing health insurance, we analyse how a social value and data-driven behavioural economic model of health insurance commodifies health and wellness. We argue that legal infrastructures are central to this commodification. Through a socio-legal critique of digital health, our article makes an original contribution to broader debates on enduring postcolonial social inequalities by illustrating how infrastructural injustice manifest through datafication.
Individuals with severe mental illness face a significantly reduced life expectancy compared to the general population. Addressing key modifiable risk factors is essential to reduce these alarming rates of mortality in this population. Nutritional psychiatry has emerged as an important field of research, highlighting the important role of nutrition on mental health outcomes. However, individuals with severe mental illness often encounter barriers to healthy eating, including poor diet quality, medication-related side effects such as increased appetite and weight gain, food insecurity and limited autonomy over food choices. While nutrition interventions play a key role in improving health outcomes and should be a standard part of care, their implementation remains challenging. Digital technology presents a promising alternative support model, with the potential to address many of the structural and attitudinal barriers experienced by this population. Nonetheless, issues such as digital exclusion and low digital literacy persist. Integrating public and patient involvement, along with behavioural science frameworks, into the design and delivery of digital nutrition interventions can improve their relevance, acceptability and impact. This review discusses the current and potential role of digital nutrition interventions for individuals with severe mental illness, examining insights, challenges and future directions to inform research and practice.
Digital innovation has the potential to be transformative to both clinical practice and academic research related to mental health. Recent advances in research and consumer-grade technology, combined with society’s rapid and widespread adoption of digital technology, has created an emerging and dynamic field attracting the interest of clinicians, researchers, and service-users alike. In this chapter we summarise potential applications of digital technology to mental health research and clinical practice, including digital phenotyping, smartphone applications, virtual reality, and teletherapy. We summarise how digital technologies might be applied to enhance psychiatric assessment and treatment, as well as in research settings. In particular, we outline the potential benefits of digital technology as clinical and research tools. We also explore the challenges associated with digital innovation in mental health, including ethical concerns, methodological considerations when critiquing research in this field, and considerations from the service-user perspective.
The high incidence of new cases of anxiety disorders highlights the need for scalable preventive interventions, which can be achieved through information and communication technologies. To our knowledge, no meta-analysis has been conducted to evaluate purely digital preventive interventions for anxiety in all types of populations. The aim of this study was to assess the effectiveness of digital interventions for the prevention of anxiety disorders. Systematic searches were conducted in six electronic databases (PubMed, PsycINFO, EMBASE, Web of Science, OpenGrey, and CENTRAL) from inception to December 12, 2024. Inclusion criteria for the studies were as follows: (1) randomized controlled trials (RCTs), (2) psychological or psychoeducational digital interventions to prevent anxiety, and (3) all types of populations without anxiety at baseline of the study. A total of 15 studies (19 comparisons; 6093 participants) were included in the systematic review. One study was identified as an outlier and was therefore excluded from the meta-analysis. The pooled analysis showed a small effect in favor of preventive interventions among non-anxious and varied populations (standardized mean difference = −0.32, 95% confidence interval: −0.44 to −0.20; p < 0.001). Sensitivity analyses supported the robustness of this finding. We found no evidence of publication bias. Heterogeneity was high, however, a meta-regression that included one variable (country, the Netherlands) explained 100% of the variance. All RCTs, except two, had a high risk of bias, and the quality of the evidence, according to Grading of Recommendations Assessment, Development, and Evaluation, was very low. There is a need to develop and evaluate new digital preventive interventions with a rigorous methodology.
This chapter discusses possible interpretations for the failure of COVID-19 tracking apps during the pandemic in the Western world in the context of digitalisation. It revisits the impact of digitalisation in public law and examines specific norms governing the right to health. The chapter explores key barriers, including privacy concerns, technological limitations, and public distrust, that contributed to the inefficacy of these digital tools. By analysing these challenges, the study identifies lessons for future digital health policies, emphasising the need for transparent governance, legal safeguards, and public engagement. It argues that human rights law must evolve to better balance privacy with public health objectives, ensuring digital technologies enhance rather than undermine fundamental rights.
The implementation of electronic health records (EHRs) in mental health contexts has been slow. Reasons for this include concerns from healthcare professionals regarding the collection of sensitive information and the stigma associated with mental health services. Despite the low uptake of EHRs, the benefits include patients feeling empowered and in control of their own treatment. However, ethnically diverse groups often access mental health services through crisis pathways and have been found to disengage with EHRs. The aim of this review was to explore ethnically diverse groups’ perceptions of the utility of mental health EHRs and establish perceived barriers and facilitators to access. MEDLINE, CINAHL, EMBASE, Scopus, PsycINFO, PubMed and Web of Science were searched. Included papers mentioned ethnically diverse groups from the 37 listed countries in the Organisation for Economic Co-operation and Development, and included service users, clients or patients accessing EHRs in mental healthcare settings. Papers were required to be published between 2009 and 2025. Eight papers met all criteria for inclusion, and three themes emerged: language barriers to EHR access, lack of access to technology and perceived impact of EHRs on access to care. Language barriers to EHR access, no access to technology and stigma were significant issues for ethnically diverse groups due to concerns about who has access to the electronic health data. Benefits of accessing EHRs included easier and efficient access to records. EHRs are critical for modern health systems and further work is required to improve EHRs usage in mental health systems for ethnically diverse groups.
Decentralized clinical trials (DCTs) are often hindered by challenges in remotely capturing biomarkers. To address this gap, we developed MyTrials, a mobile application integrated with REDCap, designed to facilitate the remote capture of biomarkers via Bluetooth-enabled remote patient monitoring (RPM) devices. The purpose of the present study was to evaluate the feasibility and acceptability of MyTrials among participants within a DCT design.
Methods:
In this four-arm randomized trial, 47 participants were allocated to receive zero, one, two, or three RPM devices. Participants were asked to use their devices once per week for a total of four weeks to remotely provide biomarkers via MyTrials. Feasibility was assessed using objective metrics of successful biomarker submission (i.e., valid device data accompanied by a video confirming participant identity) alongside the participant-reported Feasibility of Intervention Measure (FIM). Acceptability was evaluated via the Acceptability of Intervention Measure (AIM) and the System Usability Scale (SUS).
Results:
Among participants assigned at least one device, the successful biomarker submission rate was 74% across all study weeks. FIM and AIM scores exceeded prespecified feasibility benchmarks across all conditions except the zero-device condition. SUS scores consistently indicated high usability across all conditions (range: 77.29–94.29).
Conclusions:
The MyTrials platform is a feasible and acceptable solution for remote biomarker capture in DCTs. These findings support the potential of MyTrials to advance remote data collection in clinical research.
Advancements in healthcare have significantly improved the prospect of patients with CHD, with over 97% now surviving adulthood. This growing population requires lifelong care and support to manage their condition. Digital health innovations, such as the “Ask Me Anything” (AMA) tool, aim to empower patients and improve collaboration with clinicians.
Methods:
In this pilot study, 70 patients were invited to participate, and 58 completed the questionnaire (response rate: 82.9%). Patients completed a digital question prompt list (QPL) prior to their consultations to select key topics from a predefined list of questions. Permission from the institution was obtained before conducting the pilot study.
Results:
Patients frequently selected questions related to prognosis, ageing, emotional well-being, lifestyle, and potential future interventions. The tool allowed for more personalised consultations and promoted active patient participation.
Conclusions:
The AMA tool demonstrates feasibility in engaging ACHD patients and supporting shared decision-making. Further research is needed to optimise system integration and evaluate long-term outcomes.
In our digital world, reusing data to inform: decisions, advance science, and improve people’s lives should be easier than ever. However, the reuse of data remains limited, complex, and challenging. Some of this complexity requires rethinking consent and public participation processes about it. First, to ensure the legitimacy of uses, including normative aspects like agency and data sovereignty. Second, to enhance data quality and mitigate risks, especially since data are proxies that can misrepresent realities or be oblivious to the original context or use purpose. Third, because data, both as a good and infrastructure, are the building blocks of both technologies and knowledge of public interest that can help societies work towards the well-being of their people and the environment. Using the case study of the European Health Data Space, we propose a multidimensional, polytopic framework with multiple intersections to democratising decision-making and improving the way in which meaningful participation and consent processes are conducted at various levels and from the point of view of institutions, regulations, and practices.
The advent of the digital age has brought about significant changes in how information is created, disseminated and consumed. Recent developments in the use of big data and artificial intelligence (AI) have brought all things digital into sharp focus. Big data and AI have played pivotal roles in shaping the digital landscape. The term ‘big data’ describes the vast amounts of structured and unstructured data generated every day. Advanced analytics on big data enable businesses and organisations to extract valuable insights, make informed decisions and enhance various processes. AI, on the other hand, has brought about a paradigm shift in how machines learn, reason and perform tasks traditionally associated with human intelligence. Machine-learning algorithms, a subset of AI, process vast datasets to identify patterns and make predictions. This has applications across diverse fields, including health care, finance, marketing and more. The combination of big data and AI has fuelled advancements in areas such as personalised recommendations, predictive analytics and automation in all aspects of our day-to-day lives.
Supporting a family member with cancer poses significant challenges for family caregivers, who have unmet supportive care needs. Psychosocial oncology professionals (PSOP) are often the primary source of support for cancer caregivers in Iran. Given the lack of supportive care resources, innovative strategies are needed to support caregivers. This study explores the views of PSOP and caregivers regarding the challenges, potential solutions, and the role of digital technologies in supporting caregivers.
Methods
Employing a qualitative descriptive design, we conducted individual interviews and focus groups with 30 participants (15 PSOPs and 15 caregivers), recruited from five settings in Tehran, Iran(2023-2024). All sessions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.
Results
PSOP identified challenges in delivering psychosocial care to caregivers , including inconsistency, uncertainty, and fragmented use of technology. Their recommendations included flexible psychosocial care via blended multi-modal digital technologies, professional development opportunities, and formal recognition and integration within the oncology setting. Caregivers experiencing frustration with the healthcare system expressed a need for family-centered care, flexible psychosocial care, and organized peer support networks.
Significance of results
Current psychosocial care in Iran is insufficient and misaligned with the preferences of PSOP and caregivers. PSOP and caregivers advocate for flexible psychosocial care through blended digital strategies. Public health strategists in Iran, as a low-resource setting with a family-centered context, should optimize resource utilization by prioritizing the training of PSOP, developing blended digital interventions, and leveraging trained peers to provide navigation and support to families, thereby easing the PSOP workload.
Physical activity (PA) promotion in primary healthcare is an effective way of addressing population-based physical inactivity. Advancements in technology could help overcome barriers to promoting PA. This scoping review aims to provide an overview of technology (digital health) for PA promotion in primary healthcare, including effectiveness and acceptability, from research published between January 2020 and December 2023.
Methods:
A scoping review was conducted across five databases (Cochrane library, Embase, MEDLINE, PubMed and WebofScience). Search terms focused on three components: PA counselling, technology and primary healthcare. Articles from 01/01/2020 to 05/12/2023 were included. Paediatric populations and populations with diseases requiring specialist care were excluded.
Results:
Of 2717 studies identified during database searches, twenty-nine were included in the review. Mobile-phone applications were the preferred method of implementation (n = 12, 52%), with most interventions aiding in assessment of PA levels (n = 16, 70%) and/or assisting in addressing it (via education, monitoring or support) (n = 22, 96%). Findings revealed mixed evidence on the effectiveness of digital health interventions in increasing PA but reported widespread acceptability of digital health interventions. Qualitative studies revealed three main themes desired by stakeholders: (1) ease of use, (2) complements pre-existing primary healthcare provision and (3) patient-centred.
Conclusion:
Future research should focus on developing standardised approaches for assessing digital health interventions, exploring the impact on prescribing behaviours and addressing the desired features highlighted by stakeholders. Integration of technology in healthcare, including PA promotion, holds promise for enhancing access and facilitating widespread implementation.
Implementing changes to digital health systems in real-life contexts poses many challenges. Design as a field has the potential to tackle some of these. This article illustrates how design knowledge, through published literature, is currently referenced in relation to the implementation of digital health. To map design literature’s contribution to this field, we conducted a scoping review on digital health implementation publications and their use of references from nine prominent design journals. The search in Scopus and Web of Science yielded 382 digital health implementation publications, of which 70 were included for analysis. From those, we extracted data on publication characteristics and how they cited the design literature. The 70 publications cited 58 design articles, whose characteristics were also extracted. The results show that design is mainly cited to provide information about specific design methods and approaches, guidelines for using them and evidence of their benefits. Examples of referenced methods and approaches were co-design, prototyping, human-centered design, service design, understanding user needs and design thinking. The results thus show that design knowledge primarily contributed to digital health implementation with insights into methods and approaches. In addition, our method showcases a new way for understanding how design literature influences other fields.
Early interventions supporting parental sensitivity have proven effective. Despite advancements in telemedicine, research on remote group parenting interventions remains limited. This study evaluated the feasibility and acceptability of “C@nnected,” a brief group videoconferencing intervention aimed at enhancing maternal sensitivity in mother–infant dyads in primary care settings in Santiago, Chile. A feasibility randomized controlled trial (RCT) was conducted using quantitative and qualitative methods. Of 44 mother–infant dyads randomized, 26 were assigned to receive the intervention, whereas 18 were allocated to the control group. Eligibility and recruitment rates were 89% and 36%, respectively, with adherence at 50% and follow-up at 64.5%. The intervention demonstrated high acceptability in both the quantitative and qualitative evaluations. Mothers who participated in the intervention showed high scores in credibility and expectancy and reported increased knowledge, stronger bonds with their children and greater satisfaction and competence in their motherhood role. This pilot study underscores the potential of “C@nnected” while identifying areas for improvement. The findings provide valuable insights into refining and further evaluating its efficacy through an RCT.